Urinary tract infections linked to acute psychosis relapse

Patients with an acute episode of psychosis have a high incidence of urinary tract infections (UTIs), report researchers.

The incidence was increased relative to healthy controls and the association was present for both affective and nonaffective psychosis, say study author Brian Miller (Georgia Regents University, Augusta, USA) and colleagues.

If the associations hold in future studies it “would suggest that antibiotic prophylaxis for UTI might decrease relapse risk in some patients”, the team writes in the Journal of Clinical Psychiatry.

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The 340 study participants were admitted to hospital with an acute episode of a DSM-IV psychotic disorder. Of the 134 with nonaffective psychosis, 21% proved to have a UTI, as did 18% of the 101 patients with affective psychosis.

These rates were significantly higher than the 3% prevalence among 39 healthy control participants. The prevalence was also increased among 105 acutely psychotic patients with alcohol use disorders, at 12%, but this was not significant relative to the controls.

Across all the groups, women were more likely than men to have a UTI, but this was the only significant association. This association remained after accounting for confounders, at a 5.3-fold risk increase, while nonaffective psychosis was associated with a 10.7-fold increase and major depressive disorder an 8.9-fold increase in UTI risk.

The likelihood of patients having a UTI was not related to their symptoms, number of previous hospitalisations, length of current stay or functional status at discharge.

“Our findings [...] highlight the potential importance of monitoring for UTI as a routine part of health screening in relevant patient populations,” say Miller et al. “Recognition and treatment of UTI in acute psychiatric inpatients may also decrease risks of other adverse events during hospitalization.”

They conclude: “Taken together, infections appear relevant to the etiopathophysiology of relapse and increased premature mortality risk in the psychoses.”

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